Abstract
The purposes of this study were to evaluate possible effects of lithium on thyroid function, determine the relationship among thyroid function, antibody levels, and demographic/clinical variables, and establish the prevalence of lithiumrelated goiter, clinical hypothyroidism, and thyroid antibodies. Forty-nine patients who had taken lithium for a minimum of 6 months were enrolled, as were 46 age- and sex-matched controls naïve to lithium use. Blood was drawn to measure levels of total and free T3, T4, thyroid-stimulating hormone (TSH), and antimicrosomal and antithyroglobulin antibodies. Thyroid volume was quantified on ultrasonography. Twenty-nine patients in the study group (59%) and 7 in the control group (15%) had goiter. Free T4 levels were significantly lower in the study group, and TSH levels were higher. Among lithium-treated patients, 12% had clinical hypothyroidism and 2% had subclinical hypothyroidism. Thyroid antibodies were present in 23% of the lithium group and 15% of the control group. No significant relationship was apparent among thyroid antibodies, thyroid volume, and clinical hypothyroidism. Our findings suggested that along with its goitrogenic effects, lithium inhibited thyroid function and led to clinical hypothyroidism. Older age, family history of thyroid disorders, and the presence of thyroid antibodies significantly influenced thyroid function in the present study.
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References
Jacobson JL, Jacobson MA. Mood-stabilizing agents. In: Jacobson JL, ed.Psychiatric Secrets. Canada: Times Mirror Professional Publishing; 1996:277–285.
Fernandez BA. Autoimmune thyrotoxicosis during lithium therapy in a patient with manicdepressive illness.Am J Med. 1995;99:575.
Honig A, Arts BMG, Ponds RHWM, Riedel WJ. Lithium induced cognitive side-effects in bipolar disorder: a qualitative analysis and implications for daily practice.Int Clin Psychopharmacol. 1999; 14:167–171.
Deodhar SD, Sing B, Pathak MC, Sharan P, Kulhara P. Thyroid functions in lithium-treated psychiatric patients.Biol Trace Element Res. 1998;67:151–163.
Gekenberg JA, Hopkins SH, Delgada LP. Mood stabilizers. In: Tasman A, Kay J, Lieberman AJ, eds.Psychiatry. Philadelphia: WB Saunders; 1997:1586–1605.
Kleiner J, Altshuler L, Hendrick V, Hersman MJ. Lithium-induced subclinical hypothyroidism: review of the literature and guidelines for treatment.J Clin Psychiatry. 1999;60:255–294.
Bhandari S. Lithium-induced hypothyroidism.Br J Psychiatry. 2000;176:95.
Johnston MA, Eagles MJ. Lithium-associated clinical hypothyroidism.Br J Psychiatry. 1999;175: 336–339.
Bocchetta A, Bernardi F, Pedditzi M, et al. Thyroid abnormalities during lithium treatment.Acta Psychiatr Scand. 1991;83:193–198.
Hassman AR, Lazarus HJ, Dieguez C, Weetman AP, Hall R, McGregor AM. The influence of lithium chloride on experimental autoimmune thyroid disease.Clin Exp Immunol. 1985;61:49–57.
Deniker P, Eyquem A, Bernheim R, Loo H, Delarue P. Thyroid autoantibody levels during lithium therapy.Neuropsychobiology. 1978;4:270–275.
Rapaport HM, Schmit EM, Risinger R, Manji H. The effects of prolonged lithium exposure on the immune system of normal control subjects: serial serum soluble interleukin-2 receptor and antithyroid antibody measurements.Biol Psychiatry. 1994;35:761–766.
Shimizu M, Hirokawa M, Manabe T, Shimozuma K, Sonoo H, Harada T. Lithium associated autoimmune thyroiditis.J Clin Pathol. 1997;50:172–174.
Lazarus HJ, McGregor MA, Ludgate M, Darke C, Creagh MF, Kingswood JC. Effect of lithium carbonate therapy on thyroid immune status in manic depressive patients: a prospective study.J Affect Disord. 1986;11:155–160.
Lee S, Chow CC, Wing KY, Shek CC. Thyroid abnormalities during chronic lithium treatment in Hong Kong Chinese: a controlled study.J Affect Disord. 1992;26:173–178.
Leroy MC, Villeneuve A, Lajeunesse C. Lithium, thyroid function and antithyroid antibodies.Biol Psychiatry. 1988;12:483–490.
Kirov G. Thyroid disorders in lithium-treated patients.J Affect Disord. 1998;50:33–40.
Perrild H, Hegedus L, Baastrup PC, Kayser L, Kastberg S. Thyroid function and ultrasonically determined thyroid size in patients receiving long-term lithium treatment.Am J Psychiatry. 1990; 147:1518–1521.
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
Lee S, Chow CC, Wing YK, et al. Thyroid function and psychiatric morbidity in patients with manic disorder receiving lithium therapy.J Clin Psychopharmacol. 2000;20:204–209.
Bocchetta A, Cherchi A, Loviselli A, et al. Six-years follow-up of thyroid function during lithium treatment.Acta Psychiatr Scand. 1996;94:45–48.
Loviselli A, Bocchetta A, Mossa P, et al. Value of thyroid echography in the long-term follow-up of lithium-treated patients.Neuropsychobiology. 1997;36:37–41.
Kusalic M, Engelsmann F. Effect of lithium maintenance therapy on thyroid and parathyroid function.J Psychiatry Neurosci. 1999;24:227–233.
Yamagishi S, Yokoyama-ohta M. A case of lithium-associated hyperthyroidism.Postgrad Med. 1999;75:188–189.
Sawin CT, Castelli WP, Hershman JM, McNamara P, Bacharach P. The aging thyroid: thyroid deficiency in the Framingham study.Arch Intern Med. 1985;145:1386–1388.
Wilson R, McKillop HJ, Crocket GT, et al. The effect of lithium therapy on parameters thought to be involved in the development of autoimmune thyroid disease.Clin Endocrinol. 1991;34: 357–361.
Valle J, Ayuso-Gutierrez JL, Abril A, Ayuso-Mateos LJ. Evaluation of thyroid function in lithiumnaive bipolar patients.Eur Psychiatry. 1999;14:341–345.
Frye AM, Kirk D, Denicoff K, et al. Association between lower serum free T4 and greater mood instability and depression in lithium-maintained bipolar patients.Am J Psychiatry. 1999;156: 1909–1914.
Kupka RW, Hillegers MHJ, Nolen WA, Breunis N, Drexhage HA. Immunological aspects of bipolar disorder.Bipolar Disord. 2000;12:86–90.
Hagherty JJ, Silva SG, Marquardt M, et al. Prevalence of antithyroid antibody in mood disorder.Depress Anxiety. 1997;5:91–96.
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Ozpoyraz, N., Tamam, L. & Kulan, E. Thyroid abnormalities in lithium-treated patients. Adv Therapy 19, 176–184 (2002). https://doi.org/10.1007/BF02848693
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DOI: https://doi.org/10.1007/BF02848693